Justice News

Nursing Agency Operator to be Incarcerated for 92 Months and Forfeits Home

BOSTON – The owner of a home nursing agency was sentenced yesterday to 92 months in prison for fraudulently billing millions of dollars of services to Medicare and then laundering the proceeds.

Michael Galatis, 63, of Natick, was sentenced by U.S. District Court Judge Douglas P. Woodlock to 92 months in prison, three years of supervised release, and ordered to pay a $50,000 fine, $7 million in restitution to Medicare, and to forfeit proceeds of the fraud scheme, including his house, valued at $850,000. Galatis was convicted following a 16-day trial in December 2014 of conspiracy to commit health care fraud, ten counts of health care fraud, and seven counts of money laundering.

Galatis, who is also a registered nurse, owned and operated At Home VNA (AHVNA), a home health agency located in Waltham. From 2006 to 2012, Galatis submitted more than $27 million in false and fraudulent home health care claims to Medicare. Medicare paid AHVNA more than $20 million of those fraudulent claims.

The Medicare program pays for home health services only if the services are medically necessary and the individual is homebound. Galatis ignored these requirements and trained AHVNA nurses to recruit healthy individuals with Medicare insurance who lived in large apartment buildings. Galatis held “wellness clinics” at these buildings where nurses convinced senior citizens to enroll with AHVNA and have a nurse visit them in their home. Galatis, and his co-conspirator, trained AHVNA nurses to manipulate the patients’ Medicare assessment forms to make it appear as though the patients qualified for Medicare home health services, when that was often not the case. Galatis paid a physician, Dr. Spencer Wilking, to sign the home health care orders, even though Dr. Wilking did not examine the vast majority of AHVNA’s patients.

Evidence at trial revealed the patients’ primary care physicians did not refer the patients to AHVNA and were unaware that AHVNA was sending nurses to see their patients in their homes. A number of these physicians complained to Galatis, informing him that the patients did not need a visiting nurse, but Galatis ignored these complaints. Similarly, AHVNA’s nurses testified that they informed Galatis that the patients did not need a visiting nurse, but Galatis refused to discharge the patients and continued to bill Medicare.

In 2011, Medicare passed a new requirement that a physician certify that she or he had a face-to-face encounter with the patient about the need for home health care. Even after this regulation was enacted, Galatis continued to bill Medicare for millions of dollars of home health care even though Dr. Wilking signed each order without examining any of the patients. Galatis used the proceeds of the fraud scheme to purchase a house currently valued at $850,000 in Natick free and clear of a mortgage.

Janice Troisi, also a registered nurse and the AHVNA clinical director, is scheduled to go to trial on July 27, 2015. Dr. Wilking, who pleaded guilty in February 2014 to health care fraud, is scheduled to be sentenced on Sept. 22, 2015.

United States Attorney Carmen M. Ortiz; Philip Coyne, Special Agent in Charge of the U.S. Health and Human Services, Office of Inspector General, Office of Investigations; Vincent B. Lisi, Special Agent in Charge of the Federal Bureau of Investigation, Boston Field Division; and William P. Offord, Special Agent in Charge of the Internal Revenue Service’s Criminal Investigation in Boston, made the announcement. The case was being prosecuted by Assistant U.S. Attorneys David S. Schumacher and Lisa A. Schlatz of Ortiz’s Health Care Fraud Unit. The trial team was also assisted by the New England Benefit Integrity Support Center, a fraud contractor for the Medicare program.